Interview with Professor Eduardo Cazap
Editor’s Note: 2023 Chinese Congress of Holistic Integrative Oncology (2023 CCHIO) will be held in Tianjin from November 16th to 19th, 2023. Professor Eduardo Cazap, who is the Founder and first president of the Latin American & Caribbean Society of Medical Oncology (SLACOM), will attend this congress.He was interviewed by Oncology Frontier on the eve of 2023 CCHIO.
Oncology Frontier: Could you please introduce the epidemic characteristics and current diagnosis and treatment status of cancer in Latin America and the Caribbean?
Prof. Eduardo Cazap：I would like to address two distinct points for this question: one focusing on the epidemiology in Latin America, and the other discussing the diagnosis and treatment of cancer in the Caribbean. Latin America encompasses many countries, including Mexico in North America, various Central American countries, South American nations, as well as numerous islands and smaller countries in the Caribbean region. Within this vast region, there exists diverse epidemiological characteristics about cancer. A prominent feature is the notable distinctions between the Atlantic and Pacific sides of the continent. On the Atlantic side, which includes countries like Brazil, Argentina, Uruguay, and parts of Mexico, the distribution of cancer is very similar to that of Western and Northern nations. Predominantly, there are high incidences of breast cancer in women, colon cancer, lung cancer, and prostate cancer in men. Additionally, cervical cancer is a significant concern for women across all Latin American countries. Unfortunately, the region is lack of effective prevention methods for this particular type of cancer. Sadly, it predominantly affects young women, aged between 20 and 40. So, cervical cancer is a priority in our region. On the other side of the continent, including Chile, Peru, Colombia, and parts of Mexico, we observe a similar cancer distribution pattern. However, due to the Pacific region’s connection to the Orient, particularly Japan, there is a prevalence of cancers such as gallbladder and gastric, aligning with the distribution seen in the Japanese population. Additionally, lung, colon, and breast cancers are noteworthy. Among these, breast cancer ranks as the most prevalent cancer among women in all countries of the region, except for Paraguay, where cervical cancer holds the first position and breast cancer follows closely as the second. This provides a concise overview of the cancer epidemiology in the Latin American region.
The second point pertains to diagnosis and treatment, and it is crucial to acknowledge the three major models of cancer care worldwide. In one model, which is like the paradigm in the US, the primary responsibility for care rests with the individual. Here, personal insurance plays a pivotal role, as government protection is relatively limited. Presently, though there may be changes in the future, personal responsibility remains integral to receiving care. Consequently, over 50, 60, or even 70 million US citizens find themselves without insurance, leaving them without coverage for cancer treatments—an even worse situation than in many Latin American countries. Another model of cancer care places the maximum responsibility on the government. This is exemplified by countries like the UK, Canada, France, Spain, and certain regions of China. My understanding is that China has a robust and widespread coverage for its population, aligning it with this group of countries. In the context of Latin America, most nations operate on a mixed system. The government typically shoulders the responsibility for the basics, while additional coverage may be obtained through private means.
Basic cancer treatments, including surgery, are also covered by various structures, such as unions or the armed forces, in addition to the government. The armed forces often have their own independent healthcare system. Additionally, in federal countries, provinces may play a role in healthcare provision, though their contribution is usually less than 10 percent. Private insurance plays a significant role in Mexico, Brazil, Argentina, and part of Peru. However, this is primarily accessible to the middle and upper economic classes of the population. Typically, populations with lower economic means are covered by national or provincial healthcare systems. Government bodies usually oversee prevention efforts, but the level of emphasis on prevention can vary significantly from one country to another. In general, the allocation of resources for prevention measures tends to be relatively low. The primary focus of government efforts often lies in the establishment and management of hospitals. While this is the prevailing approach, prioritizing prevention measures is crucial for a more effective global cancer control strategy.
In Latin America, access to treatment is a major concern. While there are established norms and guidelines, as well as responsibilities for healthcare providers, the issue often lies in delays and system overload. In some cases, individuals in need of procedures like mastectomies or colon surgeries may face delays of two to four months. This represents a significant limitation in the healthcare system. Additionally, healthcare provision is not uniform across the board. Larger cities generally have well-developed healthcare infrastructure, while provinces and remote regions, including jungle areas, face challenges in providing optimal care. Geographical constraints further compound the issue.
Oncology Frontier: What is your vision and perspectives for global cancer control?
Prof. Eduardo Cazap：I believe there may be some misconceptions about the concept of globality. The current level of connectivity, allowing us to communicate over long distances with images, is undoubtedly a global achievement. The networks, information, and connections linking people across the world constitute a global phenomenon. However, when it comes to health, health is not global; it operates on a country-by-country basis. Therefore, applying a universal standard of quality to health becomes less feasible. This is because, in nearly 99% of cases, the responsibility for cancer care lies at the local level, managed by individuals and governments within each country. Yet, within this global scope, there exist regions, and in contrast to highly organized regions like Europe, Latin America may not be as uniformly structured. Hence, I believe we require a multi-dimensional strategy that incorporates top-down and down-top approaches.
International organizations like the WHO, PAHO in the Americas, IARC in Lyon, and IAEA for nuclear medicine in Austria play a guiding role in making general decisions. However, it is imperative for each country to develop and implement its own cancer control plan, taking into account its economic and healthcare resources, as well as establishing a cancer registry. These are the two foundational tools: country-level cancer registries for accurate patient counts and disease incidence data, and national cancer plans for the effective implementation of strategies. While global efforts have been made, they may not be as extensive as desired. In 2010, the United Nations Assembly issued recommendations for global cancer control. However, over the past 12 to 13 years, the situation has evolved considerably. Therefore, the responsibility lies with individual governments and civil societies within each country, including those in Latin America, to take proactive measures in addressing cancer control within their respective regions.
Oncology Frontier: How do you view the significance of cooperation and exchange between CACA and SLACOM for cancer control in developing countries?
Prof. Eduardo Cazap：That is a good question, as some of our members have also wondered about the rationale behind cooperating with China. The vast differences in culture and country size compared to other regions in the world might raise concerns. However, it’s important to consider that many of the recommended guidelines and advancements in cancer research have originated from a handful of countries like the USA, Japan, Germany, Spain, England, and Australia. As a result, the studies and findings primarily reflect Western perspectives. So, how can we confidently apply a cancer treatment that was studied in American women to a woman of, say, Indian descent in Peru? Can we be certain that their genetic makeup is the same? Can we expect the cancer’s progression to be similar? At this juncture, understanding the distinctions between various ethnic groups is crucial. In the case of Latin America, for instance, Peru boasts a significant population with Chinese and Japanese roots. Therefore, gathering information about diverse populations worldwide is essential, especially given the increasing migrations and extensive global travel opportunities, which have contributed to a genetic diversity that is far less uniform than it was a century ago.
For example, collaborating with Chinese colleagues offers us a fantastic opportunity to gain insights into different population dynamics. Simultaneously, the low-cost strategies that many Latin American countries have developed may prove beneficial for the Chinese population, potentially impacting millions of individuals. In our countries, we’ve replaced costly and complex diagnostic interventions with more affordable and straightforward alternatives, which could also benefit the Chinese population. We anticipate that this collaboration will be fruitful, enriching the knowledge of our colleagues from both China and Latin America for the collective benefit of all countries involved.
